Clinical Outcomes and Treatment Course of Eyes with Neovascular Age-Related Macular Degeneration Following the Development of Endophthalmitis
Retina (Philadelphia, Pa.)
PURPOSE: To evaluate the clinical course of patients with neovascular age-related macular degeneration (nAMD) after developing endophthalmitis during their treatment with intravitreal injections.
METHODS: Multicenter, retrospective series.
RESULTS: From April 2013 to October 2018, 196,598 intravitreal anti-vascular endothelial growth factor (VEGF) injections were performed, with 75 cases of endophthalmitis (incidence 0.0381%). There was no association between intravitreal anti-VEGF drug (P = 0.29), anesthetic method (P = 0.26), povidone concentration (P = 0.22), or any intraprocedure variable and endophthalmitis incidence. Seventy-two patients (96%) were treated with intravitreal tap and inject , while 3 underwent immediate pars plana vitrectomy. After endophthalmitis resolution, 17 patients (22.7%) were not re-treated for nAMD (in 10 cases due to inactive disease; follow-up, 115 ± 8.4 weeks). Patients required less frequent anti-VEGF injections after infection (7.4 ± 0.61 weeks vs. 11.5 ± 1.8 weeks; P = 0.004). Preinfection logarithm of the minimum angle of resolution visual acuity was 0.585 ± 0.053 (∼20/77). It worsened with endophthalmitis (1.67 ± 0.08, ∼20/935; P < 0.001) and again on postendophthalmitis treatment day 1 (1.94 ± 0.064; count fingers; P < 0.001), but improved after reinitiating nAMD therapy (1.02 ± 0.11; ∼20/209; P < 0.001). Better visual acuity on postendophthalmitis week 1 (P = 0.002) and reinitiation of nAMD treatment (P = 0.008) were associated with better final visual acuity, and streptococcal culture with worse visual acuity (P = 0.028). The postendophthalmitis treatment interval was associated with the anti-VEGF drug used (aflibercept = ranibizumab > bevacizumab; P < 0.001).
CONCLUSION: Patients with nAMD required fewer injections after endophthalmitis, suggesting a biological change in disease activity. Neovascular age-related macular degeneration became quiescent in 13.3% of eyes. Most achieved better outcomes with anti-VEGF reinitiation.
Koulisis N, Moysidis SN, Govindaraju VK, Dersch AM, Capone A Jr, Covert DJ, Dadgostar H, Dass AB, Drenser KA, Engstrom RE Jr, Faia LJ, Garretson BR, Guerami AH, Hanscom TA, Mahmoud TH, Margherio AR, Oh KT, Randhawa S, Raphaelian PV, Rhoades WR, Ruby AJ, Sanfilippo CJ, Sneed SR, Trese MT, Wolfe JD, Williams GA, Yedavally S, Hassan TS. Clinical Outcomes and Treatment Course of Eyes with Neovascular Age-Related Macular Degeneration Following the Development of Endophthalmitis. Retina. 2021 Jun 1;41(6):1242-1250. doi: 10.1097/IAE.0000000000002998. PMID: 33079789.